In June 2014, the US Supreme Court ruled that some employers can decide for themselves whether the contraceptive mandate in the Affordable Care Act (ACA) is a substantial burden on the exercise of religious freedom (Box)2 and sue for an exemption on that basis. What are the broader implications of this decision for medical care?

A large, family-owned company, Hobby Lobby, objected to including contraceptive coverage—specifically, intrauterine devices and emergency contraception—in their employees' health insurance because the owners viewed these forms of birth control as “abortions.” But, consistent with a disturbing trend among courts and legislatures to misstate or misuse scientific information in the context of women's reproductive rights and health,3 the Supreme Court's decision ignored the well-accepted distinction between contraception and abortion.4